N. Harsas, Rana Amanda, S. Purwowiyoto, Hillary Kusharsamita
There is substantial evidence that patients with obstructive sleep apnea (OSA) have a higher incidence of cardiovascular disease (CVD). However, the exact mechanism that links OSA with CVD is still insufficiently understood and often underdiagnosed and undertreated. This review aims to summarize the pathomechanisms coexistence of OSA and CVD and a diagnostic evaluation of the treatment options for OSA. The Pubmed was searched using the keywords “OSA;” and “CVD.” Related papers published from 2013 to February 2022 were chosen. OSA has been associated with intermittent hypoxemia, significant intrathoracic pressure changes, and arousal from sleep, all of which have been linked to adverse health effects, particularly in the case of CVD. The need for the early detection of CVD patients and OSA screening is critical. Screening techniques include identifying specific OSA symptoms through medical history, using screening questionnaires or devices, followed by diagnostic testing thorough sleep evaluation that differs depending on the underlying cardiovascular condition. The need to improve the early diagnosis and treatment of OSA, a highly prospective modifiable CVD risk factor, is crucial given the growing body of research on the relationship between OSA and CVD as well as the effectiveness of OSA treatment.
{"title":"Coexistence of obstructive sleep apnea and cardiovascular disease: A narrative review","authors":"N. Harsas, Rana Amanda, S. Purwowiyoto, Hillary Kusharsamita","doi":"10.4103/cmi.cmi_101_22","DOIUrl":"https://doi.org/10.4103/cmi.cmi_101_22","url":null,"abstract":"There is substantial evidence that patients with obstructive sleep apnea (OSA) have a higher incidence of cardiovascular disease (CVD). However, the exact mechanism that links OSA with CVD is still insufficiently understood and often underdiagnosed and undertreated. This review aims to summarize the pathomechanisms coexistence of OSA and CVD and a diagnostic evaluation of the treatment options for OSA. The Pubmed was searched using the keywords “OSA;” and “CVD.” Related papers published from 2013 to February 2022 were chosen. OSA has been associated with intermittent hypoxemia, significant intrathoracic pressure changes, and arousal from sleep, all of which have been linked to adverse health effects, particularly in the case of CVD. The need for the early detection of CVD patients and OSA screening is critical. Screening techniques include identifying specific OSA symptoms through medical history, using screening questionnaires or devices, followed by diagnostic testing thorough sleep evaluation that differs depending on the underlying cardiovascular condition. The need to improve the early diagnosis and treatment of OSA, a highly prospective modifiable CVD risk factor, is crucial given the growing body of research on the relationship between OSA and CVD as well as the effectiveness of OSA treatment.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"40 1","pages":"62 - 67"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76676471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Adolescent sleep deprivation affects their mental health, cardiovascular health, academic performance, and safety while on the road. This study analyzed sleep quality, hygiene, and daytime sleepiness among adolescents attending a tertiary care medical institution in Vellore. Materials and Methods: A school-based self-reported survey was conducted among 257 adolescents using the Adolescent Sleep–Wake Scale, Adolescent Sleep Hygiene Scale, and Epworth Sleepiness Scale. Unpaired t-test was used for continuous variables and Chi-square test for discrete variables for analysis. The correlation between sleep hygiene, sleep quality, and daytime sleepiness was done using Pearson correlation coefficient. Results: The mean age of participants was 14.5 ± 1.08 years. During weekdays, the mean bedtime was 9:39 pm ± 44 min and wake time 6:20 am ± 56 min. During weekends, the mean bedtime was 9:53 pm ± 49 min and wake time 7:03 am ± 88 min. The average duration of nighttime sleep was 8 h 40 min ± 64 min on weekdays and 9 h 10 min ± 81 min during weekends. Twelve percent experienced daytime sleepiness. There was a weak-to-moderate, inverse correlation of daytime sleepiness to sleep quality (r = −0.30) and sleep hygiene (r = −0.23). Mean scores of sleep quality and sleep hygiene were 4.25 and 4.29, respectively. There was a moderate-to-strong (r = 0.63) correlation with low scores in cognitive (mean = 3.72) and sleep stability domains (mean = 3.79). Conclusions: Adolescents in this study population have reasonably good sleep quality and hygiene. Sleep hygiene is closely related to sleep quality.
{"title":"A cross-sectional study on sleep among Indian adolescents","authors":"Mona Basker, Sataroopa Mishra, YS Reshmi, Priyanka Medhi, SnehaDeena Varkki, Grace Rebekah","doi":"10.4103/cmi.cmi_36_23","DOIUrl":"https://doi.org/10.4103/cmi.cmi_36_23","url":null,"abstract":"Background: Adolescent sleep deprivation affects their mental health, cardiovascular health, academic performance, and safety while on the road. This study analyzed sleep quality, hygiene, and daytime sleepiness among adolescents attending a tertiary care medical institution in Vellore. Materials and Methods: A school-based self-reported survey was conducted among 257 adolescents using the Adolescent Sleep–Wake Scale, Adolescent Sleep Hygiene Scale, and Epworth Sleepiness Scale. Unpaired t-test was used for continuous variables and Chi-square test for discrete variables for analysis. The correlation between sleep hygiene, sleep quality, and daytime sleepiness was done using Pearson correlation coefficient. Results: The mean age of participants was 14.5 ± 1.08 years. During weekdays, the mean bedtime was 9:39 pm ± 44 min and wake time 6:20 am ± 56 min. During weekends, the mean bedtime was 9:53 pm ± 49 min and wake time 7:03 am ± 88 min. The average duration of nighttime sleep was 8 h 40 min ± 64 min on weekdays and 9 h 10 min ± 81 min during weekends. Twelve percent experienced daytime sleepiness. There was a weak-to-moderate, inverse correlation of daytime sleepiness to sleep quality (r = −0.30) and sleep hygiene (r = −0.23). Mean scores of sleep quality and sleep hygiene were 4.25 and 4.29, respectively. There was a moderate-to-strong (r = 0.63) correlation with low scores in cognitive (mean = 3.72) and sleep stability domains (mean = 3.79). Conclusions: Adolescents in this study population have reasonably good sleep quality and hygiene. Sleep hygiene is closely related to sleep quality.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135212281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abinash Panda, Satabdi Sahu, Suryasnata Dash, YRoja Ramani, JayantiPrava Behera
Background: Fungal infections remain a major source of morbidity and mortality, but treatment choices are restricted due to limited classes of antifungal agents. The emergence of antifungal drug resistance (AFDR) is a major concern. Understanding trend in the development of AFDR will facilitate the use of therapeutic strategies to overcome and prevent antifungal resistance. The primary objective of the present study was to find out the pattern of AFDR in laboratory-confirmed mycological culture isolates. Methodology: The record-based cross-sectional study was carried out to analyze all the mycological culture sensitivity reports during a period of 3 years. The data set included clinicodemographic parameters such as age, gender, provisional diagnosis, type of culture specimens, identified fungal isolate, and susceptibility pattern. The association between the selected parameters and the pattern of AFDR was found out by Pearson's Chi-squared test. Results: AFDR among the isolates was 22 (75.86%), 8 (61.54%), 25 (100%), and 7 (70%) during the period from 2019 to 2022. The rate of AFDR was 33.87% during the study period. Antifungal susceptibility testing showed a rising trend in fluconazole resistance from 2019 (27.2%) to 2022 (57.1%). AFDR was highest in the age group of 41–60 years (48.3%), in males (72.5%), in skin scrapings (40.3%), and in cases with a provisional diagnosis of deep mycosis (51.6% in deep mycosis vs. 46.7% in superficial mycosis). The association between age, type of clinical specimen, type of mycosis, and occurrence of AFDR was statistically significant (P ≤ 0.05). The most common fungal specimen isolated was Candida albicans whereas the highest prevalence of AFDR was observed among Candida glabrata. Conclusion: In all the clinical conditions (superficial and deep mycosis), resistance to fluconazole was the predominant type of AFDR. There was a rising trend in the resistance pattern to fluconazole which is one of the most commonly used antifungal agents.
{"title":"Changing pattern of antifungal drug resistance in a tertiary health-care facility – A cross-sectional study","authors":"Abinash Panda, Satabdi Sahu, Suryasnata Dash, YRoja Ramani, JayantiPrava Behera","doi":"10.4103/cmi.cmi_63_23","DOIUrl":"https://doi.org/10.4103/cmi.cmi_63_23","url":null,"abstract":"Background: Fungal infections remain a major source of morbidity and mortality, but treatment choices are restricted due to limited classes of antifungal agents. The emergence of antifungal drug resistance (AFDR) is a major concern. Understanding trend in the development of AFDR will facilitate the use of therapeutic strategies to overcome and prevent antifungal resistance. The primary objective of the present study was to find out the pattern of AFDR in laboratory-confirmed mycological culture isolates. Methodology: The record-based cross-sectional study was carried out to analyze all the mycological culture sensitivity reports during a period of 3 years. The data set included clinicodemographic parameters such as age, gender, provisional diagnosis, type of culture specimens, identified fungal isolate, and susceptibility pattern. The association between the selected parameters and the pattern of AFDR was found out by Pearson's Chi-squared test. Results: AFDR among the isolates was 22 (75.86%), 8 (61.54%), 25 (100%), and 7 (70%) during the period from 2019 to 2022. The rate of AFDR was 33.87% during the study period. Antifungal susceptibility testing showed a rising trend in fluconazole resistance from 2019 (27.2%) to 2022 (57.1%). AFDR was highest in the age group of 41–60 years (48.3%), in males (72.5%), in skin scrapings (40.3%), and in cases with a provisional diagnosis of deep mycosis (51.6% in deep mycosis vs. 46.7% in superficial mycosis). The association between age, type of clinical specimen, type of mycosis, and occurrence of AFDR was statistically significant (P ≤ 0.05). The most common fungal specimen isolated was Candida albicans whereas the highest prevalence of AFDR was observed among Candida glabrata. Conclusion: In all the clinical conditions (superficial and deep mycosis), resistance to fluconazole was the predominant type of AFDR. There was a rising trend in the resistance pattern to fluconazole which is one of the most commonly used antifungal agents.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134883144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
India bears a significant portion of the worldwide burden of chronic and terminal illnesses. Nevertheless, there is a dearth of a standardized approach in delivering optimal end-of-life care (EOLC) to a substantial proportion of patients who have reached the terminal phase of their lives. Health-care providers are urged by health-care professionals to be aware of the cultural and spiritual beliefs and practices that can shape patients' and their families' perspectives on EOLC. They should also emphasize the importance of providing support for religious and cultural practices and involving family members in the EOLC process. Holistic care is discussed as an approach that considers the physical, emotional, spiritual, and social aspects of a patient's well-being. Healthcare providers must address ethical and legal issues when delivering EOLC and prioritize personalized care that respects patients' choices. Language and communication barriers in multicultural EOLC are identified as significant challenges. In a nutshell, the authors discuss the importance of incorporating cultural and spiritual practices in bereavement support to help patients and their families process grief and celebrate the patient's life and legacy. Overall, this article provides a comprehensive overview of the importance of cultural and spiritual awareness in EOLC for elderly patients. It emphasizes the necessity for health-care providers to deliver inclusive and culturally sensitive care, ultimately enhancing the quality of life for both individuals and their loved ones. The significance of cultural and spiritual awareness in improving EOLC for older individuals is underscored in this context.
{"title":"A peaceful passage: Enhancing end-of-life care for elderly patients through cultural and spiritual awareness","authors":"GopalSingh Charan, Manpreet Kaur, Amanpreet Kaur","doi":"10.4103/cmi.cmi_70_23","DOIUrl":"https://doi.org/10.4103/cmi.cmi_70_23","url":null,"abstract":"India bears a significant portion of the worldwide burden of chronic and terminal illnesses. Nevertheless, there is a dearth of a standardized approach in delivering optimal end-of-life care (EOLC) to a substantial proportion of patients who have reached the terminal phase of their lives. Health-care providers are urged by health-care professionals to be aware of the cultural and spiritual beliefs and practices that can shape patients' and their families' perspectives on EOLC. They should also emphasize the importance of providing support for religious and cultural practices and involving family members in the EOLC process. Holistic care is discussed as an approach that considers the physical, emotional, spiritual, and social aspects of a patient's well-being. Healthcare providers must address ethical and legal issues when delivering EOLC and prioritize personalized care that respects patients' choices. Language and communication barriers in multicultural EOLC are identified as significant challenges. In a nutshell, the authors discuss the importance of incorporating cultural and spiritual practices in bereavement support to help patients and their families process grief and celebrate the patient's life and legacy. Overall, this article provides a comprehensive overview of the importance of cultural and spiritual awareness in EOLC for elderly patients. It emphasizes the necessity for health-care providers to deliver inclusive and culturally sensitive care, ultimately enhancing the quality of life for both individuals and their loved ones. The significance of cultural and spiritual awareness in improving EOLC for older individuals is underscored in this context.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134883891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Samuel, A. Babu, V. Moses, M. Aparna, Munawwar Ahmed, G. Varghese, P. Joseph, Shyam Keshava
Background: Hydatid disease is a health problem in the developing world. Percutaneous therapy with various scolicidal agents has been described; however, there is a paucity of literature on the use of absolute alcohol injection without reaspiration as a sole scolicidal agent. The study carried out in a tertiary hospital aimed to prospectively evaluate the safety and outcomes of ultrasound-guided percutaneous injection of alcohol for liver hydatid cyst. Methodology: Consecutive patients with liver hydatid cysts were evaluated with ultrasound, classified according to the WHO classification between June 2012 and January 2020. Eligible patients underwent ultrasound-guided percutaneous therapy after three courses of oral albendazole. Patients having elevated cyst fluid bilirubin levels were excluded. Patients who underwent percutaneous alcohol injection were followed up clinically and with imaging. Data were entered in Microsoft Excel spreadsheet and analyzed. Results: Fifty-two consecutive patients with hydatid cyst were evaluated during the study. Among these, 27 patients underwent percutaneous alcohol injection. Follow-up data were available for 25 patients. There was a favorable imaging outcome in 21/25 (84%). One patient developed anaphylaxis during cyst access, which was managed medically with an uneventful recovery. No instances of cholangitis or sepsis following injection were observed. Conclusion: Percutaneous alcohol injection therapy for liver hydatid cysts is a minimally invasive, safe, and an effective procedure in selected group of patients.
{"title":"Safety of ultrasound-guided percutaneous injection of alcohol as a scolicidal agent for the treatment of liver hydatid cysts","authors":"V. Samuel, A. Babu, V. Moses, M. Aparna, Munawwar Ahmed, G. Varghese, P. Joseph, Shyam Keshava","doi":"10.4103/cmi.cmi_71_22","DOIUrl":"https://doi.org/10.4103/cmi.cmi_71_22","url":null,"abstract":"Background: Hydatid disease is a health problem in the developing world. Percutaneous therapy with various scolicidal agents has been described; however, there is a paucity of literature on the use of absolute alcohol injection without reaspiration as a sole scolicidal agent. The study carried out in a tertiary hospital aimed to prospectively evaluate the safety and outcomes of ultrasound-guided percutaneous injection of alcohol for liver hydatid cyst. Methodology: Consecutive patients with liver hydatid cysts were evaluated with ultrasound, classified according to the WHO classification between June 2012 and January 2020. Eligible patients underwent ultrasound-guided percutaneous therapy after three courses of oral albendazole. Patients having elevated cyst fluid bilirubin levels were excluded. Patients who underwent percutaneous alcohol injection were followed up clinically and with imaging. Data were entered in Microsoft Excel spreadsheet and analyzed. Results: Fifty-two consecutive patients with hydatid cyst were evaluated during the study. Among these, 27 patients underwent percutaneous alcohol injection. Follow-up data were available for 25 patients. There was a favorable imaging outcome in 21/25 (84%). One patient developed anaphylaxis during cyst access, which was managed medically with an uneventful recovery. No instances of cholangitis or sepsis following injection were observed. Conclusion: Percutaneous alcohol injection therapy for liver hydatid cysts is a minimally invasive, safe, and an effective procedure in selected group of patients.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"24 1","pages":"19 - 25"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81599003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Breast cancer: Knowledge, attitude, and practice among undergraduate student of breast self-examination as the early diagnostic tools in achievers university, Ondo State","authors":"O. Olorunfemi, OluwakemiBlessing Sule","doi":"10.4103/cmi.cmi_134_22","DOIUrl":"https://doi.org/10.4103/cmi.cmi_134_22","url":null,"abstract":"","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"C-29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84439247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dr. John S. Carman","authors":"R. George","doi":"10.4103/cmi.cmi_121_22","DOIUrl":"https://doi.org/10.4103/cmi.cmi_121_22","url":null,"abstract":"","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"25 1","pages":"1 - 2"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79456181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The stream of medicine is rapidly changing with each day, and to meet the wide range of expectations of the members of the community, a corresponding change in the process of medical training is also essential. Blended learning refers to a teaching-learning approach that comprises a systematic amalgamation of both conventional and online learning. The adoption of blended learning in medical education delivery tends to overcome the drawbacks of conventional and online learning. We must acknowledge that blended learning not only is cost-effective but also enhances learning, disseminates information, and plays an important role in creating a network of learners. To conclude, the introduction of blended learning in medical education delivery is an important curricular reform for the benefit of medical students. It is the need of the hour to systematically explore the strengths, weaknesses, opportunities, and challenges, and then takes a well-informed call about the planning and implementation of blended learning in medical institutions.
{"title":"Successful introduction of blended learning in medical education: Strengths, weaknesses, opportunities, and challenges","authors":"SaurabhRamBihariLal Shrivastava, PrateekSaurabh Shrivastava","doi":"10.4103/cmi.cmi_62_23","DOIUrl":"https://doi.org/10.4103/cmi.cmi_62_23","url":null,"abstract":"The stream of medicine is rapidly changing with each day, and to meet the wide range of expectations of the members of the community, a corresponding change in the process of medical training is also essential. Blended learning refers to a teaching-learning approach that comprises a systematic amalgamation of both conventional and online learning. The adoption of blended learning in medical education delivery tends to overcome the drawbacks of conventional and online learning. We must acknowledge that blended learning not only is cost-effective but also enhances learning, disseminates information, and plays an important role in creating a network of learners. To conclude, the introduction of blended learning in medical education delivery is an important curricular reform for the benefit of medical students. It is the need of the hour to systematically explore the strengths, weaknesses, opportunities, and challenges, and then takes a well-informed call about the planning and implementation of blended learning in medical institutions.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134883141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Priscilla Rupali, Hanna Alexander, Divya Deodhar, Jane Miracline, NaveenaGracelin Princy Zaccheus, Mahasampath Gowri, KishoreKumar Pichamuthu, Sowmya Sathyendra, Ramya Iyadurai, DevasahayamJesudas Christopher, D Pavithra
Background: The in-person postprescription review-based antimicrobial stewardship (AMS) program was disrupted in acute care settings due to the implementation of rigorous infection control measures in response to the COVID-19 pandemic. The study assessed the feasibility of a pharmacist and biomarker-driven remote AMS strategy in COVID-19 inpatients of a hospital providing tertiary-level care in southern India. Methodology: During baseline phase, patients on antibiotics >48 h were screened and antimicrobial consumption indices such as days of therapy per 1000 patient days (days on therapy [DOT]/1000PD) and length of therapy (LOT) were measured. In the intervention phase, at 48 h of antimicrobial use, procalcitonin test (PCT) was sent. Based on the PCT levels and patient's clinical condition, an electronic alert was sent to the treating team to continue/de-escalate or discontinue an antibiotic. Results: During the preintervention phase, which lasted from July to October 2020, a total of 481 patients were enrolled, whereas in the intervention phase, which ran from December 2020 to March 2021, only 90 patients were enrolled. The total DOT/1000 patient days were 9269 in the baseline and 2032 in the intervention (78% reduction). There was a significant decrease in the total length of stay (LOT) from 3779 during the preintervention phase to 657 during the intervention phase. The treating team accepted 91.1% of the recommendations provided during the intervention phase. Conclusion: A simple innovative strategy helped curb indiscriminate antibiotic use when access to patients was limited during the COVID-19 pandemic.
{"title":"Implementation of a pharmacist-driven biomarker-based remotely delivered antimicrobial stewardship strategy during the COVID-19 pandemic","authors":"Priscilla Rupali, Hanna Alexander, Divya Deodhar, Jane Miracline, NaveenaGracelin Princy Zaccheus, Mahasampath Gowri, KishoreKumar Pichamuthu, Sowmya Sathyendra, Ramya Iyadurai, DevasahayamJesudas Christopher, D Pavithra","doi":"10.4103/cmi.cmi_67_23","DOIUrl":"https://doi.org/10.4103/cmi.cmi_67_23","url":null,"abstract":"Background: The in-person postprescription review-based antimicrobial stewardship (AMS) program was disrupted in acute care settings due to the implementation of rigorous infection control measures in response to the COVID-19 pandemic. The study assessed the feasibility of a pharmacist and biomarker-driven remote AMS strategy in COVID-19 inpatients of a hospital providing tertiary-level care in southern India. Methodology: During baseline phase, patients on antibiotics >48 h were screened and antimicrobial consumption indices such as days of therapy per 1000 patient days (days on therapy [DOT]/1000PD) and length of therapy (LOT) were measured. In the intervention phase, at 48 h of antimicrobial use, procalcitonin test (PCT) was sent. Based on the PCT levels and patient's clinical condition, an electronic alert was sent to the treating team to continue/de-escalate or discontinue an antibiotic. Results: During the preintervention phase, which lasted from July to October 2020, a total of 481 patients were enrolled, whereas in the intervention phase, which ran from December 2020 to March 2021, only 90 patients were enrolled. The total DOT/1000 patient days were 9269 in the baseline and 2032 in the intervention (78% reduction). There was a significant decrease in the total length of stay (LOT) from 3779 during the preintervention phase to 657 during the intervention phase. The treating team accepted 91.1% of the recommendations provided during the intervention phase. Conclusion: A simple innovative strategy helped curb indiscriminate antibiotic use when access to patients was limited during the COVID-19 pandemic.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134884269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The changes in the left ventricle to right ventricle muscle mass ratio account for the majority of the age-related changes in pediatric electrocardiograms (ECGs). A newborn's right ventricle muscle mass is more than the newborn's left ventricle. Physiologically, newborn infants have a dominant right ventricle. Race differences in QRS voltage normal values exist. Compared to Euro-Americans, African-Americans have a higher upper normal limit of QRS voltages. Typically, right ventricular hypertrophy is seen in newborns. To distinguish between pathological and physiological newborn hypertrophy, it is critical to measure the mean QRS amplitude in healthy newborns. This is the first study on the Indian population, with previous ones being conducted among African-Americans. Methodology: Between 2015 and 2016, this prospective observational study was carried out in the pediatrics department of a tertiary care facility in India. The study included 76 term newborns who were under 3 days old. In Chennai's Kilpauk Medical College and Hospital, the newborn infants underwent clinical examinations as well as echocardiography before receiving their ECGs. A baseline questionnaire that had been previously created was used for data collection. Results: For the Indian population, the mean R wave amplitude was 11.56 mm, with a standard deviation of 2.96 mm, and the 5th and 95th percentiles were 6.85 mm and 16.15 mm, respectively. The Fridericia formula for the mean QTc interval gives a value of 357.14 ms, a standard deviation of 34.072 ms, and a 95% confidence interval of 349.36–364.93 ms. Since a newborn's heart rate typically exceeds 100 beats/min, the measurement of QTc using the Fridericia formula more accurately predicts QTc in the newborn. The mean heart rate was 125.75 beats/min, with a standard deviation of 15.44 beats/min, and the 5th and 95th percentiles were 93.7 and 149 beats/min, respectively. Conclusions: The “R” wave mean amplitude in lead V1 was 11.56 mm, with a 2.96 mm standard deviation; the fifth and ninety-fifth percentiles, respectively, were 6.85 mm and 16.15 mm. The population's “R” wave in the lead V1 exhibits racial differences in amplitude.
{"title":"Evaluation of mean “R” wave amplitude in lead V<sub>1</sub> of electrocardiogram among term newborn infants in tertiary care institution in South India","authors":"Hariharan Narasaiyan, Sathyamurthi Balasubramanian","doi":"10.4103/cmi.cmi_2_23","DOIUrl":"https://doi.org/10.4103/cmi.cmi_2_23","url":null,"abstract":"Background: The changes in the left ventricle to right ventricle muscle mass ratio account for the majority of the age-related changes in pediatric electrocardiograms (ECGs). A newborn's right ventricle muscle mass is more than the newborn's left ventricle. Physiologically, newborn infants have a dominant right ventricle. Race differences in QRS voltage normal values exist. Compared to Euro-Americans, African-Americans have a higher upper normal limit of QRS voltages. Typically, right ventricular hypertrophy is seen in newborns. To distinguish between pathological and physiological newborn hypertrophy, it is critical to measure the mean QRS amplitude in healthy newborns. This is the first study on the Indian population, with previous ones being conducted among African-Americans. Methodology: Between 2015 and 2016, this prospective observational study was carried out in the pediatrics department of a tertiary care facility in India. The study included 76 term newborns who were under 3 days old. In Chennai's Kilpauk Medical College and Hospital, the newborn infants underwent clinical examinations as well as echocardiography before receiving their ECGs. A baseline questionnaire that had been previously created was used for data collection. Results: For the Indian population, the mean R wave amplitude was 11.56 mm, with a standard deviation of 2.96 mm, and the 5th and 95th percentiles were 6.85 mm and 16.15 mm, respectively. The Fridericia formula for the mean QTc interval gives a value of 357.14 ms, a standard deviation of 34.072 ms, and a 95% confidence interval of 349.36–364.93 ms. Since a newborn's heart rate typically exceeds 100 beats/min, the measurement of QTc using the Fridericia formula more accurately predicts QTc in the newborn. The mean heart rate was 125.75 beats/min, with a standard deviation of 15.44 beats/min, and the 5th and 95th percentiles were 93.7 and 149 beats/min, respectively. Conclusions: The “R” wave mean amplitude in lead V1 was 11.56 mm, with a 2.96 mm standard deviation; the fifth and ninety-fifth percentiles, respectively, were 6.85 mm and 16.15 mm. The population's “R” wave in the lead V1 exhibits racial differences in amplitude.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135212272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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